A review of a surgical-orthodontic database revealed striking changes in the surgical treatment of skeletal Class II problems. After its development, ramus osteotomy for mandibular setback became the standard procedure and was still used in nearly half the patients treated in 1978 to 1985. Between 1985 and 1990, the number of isolated mandibular setback procedures dropped sharply, while the number of maxillary advances nearly doubled. The number of patients undergoing combined maxillary and mandibular surgery also increased. In 1990 to 1992, isolated mandibular setback was used in fewer than 10% of the patients, while maxillary advancement was used in more than 40% of the patients. The changes were influenced by improvements in surgical techniques, the demonstration that maxillary advancement is unlikely to cause speech problems in noncleft patients, and documentation that better esthetics and stability can be acheived with maxillary than with mandibular surgery.